Provider Demographics
NPI:1891966214
Name:VALLEY PEDIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VALLEY PEDIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-902-7710
Mailing Address - Street 1:9 PARK CENTER COURT
Mailing Address - Street 2:#150
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-902-7710
Mailing Address - Fax:410-902-4410
Practice Address - Street 1:9 PARK CENTER COURT
Practice Address - Street 2:#150
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-902-7710
Practice Address - Fax:410-902-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0644893208000000X
MDD0637920208000000X
MDD0058921208000000X
MDD0064508208000000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22315OtherMAMSI
LM17OtherBCBS
TM183OtherAMERIGROUP